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HomeMy WebLinkAboutZoning ComplianceOFFICE USE"ONLY DATE FILED: 1.2. 0 %- �t?0 ' p PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER: 03-I.2 ` ooff 7` CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.: 1 2. ALL INFO MUST BE COMPLETE U FILLED IN TO BE ACCEPTED In ST. LUCIE COUNTY PUBLIC WORKS BUILDING & ZONING DEPARTMENT 2300 VIRGINIA AVENUE FORT PIERCE, FL 34982-5652 772462-1553 kfxe C, APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION LOCATION/SITE ADDRESS: ._/�,og Q� a.4' .S S/D NAME: �190-e-F /na -SITE PLAN NAME: 3. PROPERTY TAX ID #: 9. 10. LEGAL DESCRIPTION (attach extra sheets if necessary): vri / Z_< PLAT 6. PAGE BOOK Ja NO. PARCEL SIZE: ACRES/SQ FT. _ DESCRIPTION OF CONGTION P{ ►xt- C C Cfr%r1 4 1.f4,41c4 G 7. BLOCK 8. LOT NO. 7 NO. Zr LOT DIMENSIONS ,RIIIE ITY: �a 11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT LEFT SIDE SIDE: 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ j INTERIOR RENOVATION [ ] RESIDENTIAL [ ] COMMERCIAL [I.]� INDUSTRIAL [ ] OTHER (SPECIFY) 13. DESCRIPTION OF PROPOSED USE: Mll&eI F'eiG r-atalF-) 14. Sq. Ft./CONSTRUCTION: J 15. Sq. Ft. 1st Floor: — 16. VALUE OF CONSTRUCTION: $ _� _/ a©`O d The value of construction is used to determine the amount of permit fees to be/assessed. SL Lucie county reserves the right to question and/ lne is $2590 modify the Indicated value of construction if it is demonstrated that the submitted figures are not consistent with similar types of construction activities. If the va ormore, a RECORDED Notice of Commencement must be submitted with this application. iKd SLCCDV Form No.: 001-02 OWNER INFORMATION: NAME: lb l (i ut ADDRESS: CITY: STATE: ZIP PHONE (DAYTIME): ( 1 IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS BELOW. FEE SIMPLE TITLEHOLDER: ADDRESS: CITY: STATE: ZIP PHONE (DAYTIME): ( 1 CONTRACTOR INFORMATION ST, of FL REG./CERT #: c rl�e BUSINESS NAME: QUALIFIERS NAME: ADDRESS: ST. LUCIE COUNTY CERT #: C71)/S&y ,e,Am e � CITY:��1 PHONE (DAYTIME): ARCHIT/ENGINEER: ADDRESS: CITY: PHONE (DAYTIME). STATE: FAX NO. __- ZIP f'�x% STATE: ZIP BONDING COMPANY:' ADDRESS: CITY: STATE: ZIP MORTGAGE LENDER: — ADDRESS: CITY: STATE: ZIP IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 days after notification it will be voided and returned to you by mail. CERTIFICATION: This application is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certificate of capacity, if applicable, for the permitted work. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits may be required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AND AIR CONDITIONERS, ETC., not otherwise included with this building permit application. The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory structures (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another non- residential use. NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. NOTICE TO APPLICANT: AS THE APPLICANT FOR THIS BUILDING PERMIT, IF IT IS NOT YOUR RIGHT. TITLE, AND INTEREST THAT IS SUBJECT TO ATTACHMENT; AS A CONDITION OF THIS PERMIT YOU PROMISE IN GOOD FAITH TO DELIVERA COPY OF THE ATTACHED CONSTRUCTION LIEN LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done In compliance with all applicable laws regulating construction and zoning. AFA • �< • �� •-ram I' STATE OF •-n• COUNTYOF. Ivy-, The foregoing instrument was acknowledged before me this day of , 20�yYA f,/ MU>r who is personally, wn to me"6rwho has produced h. Signatu of Notary Type or Prrint Nam of Notary STATE OF FLO A COUNTY OF /i LGQl� The foregoing instrument Vas acknowle�qed before me this 7day of , 20 ) b N 4i f ho is persona k own to me r who has produced as Signature 0440tary r� pllew Type of Pri t Name of Notary Notary Public Title Notary Public Title gX`�C Commission Number 2', Commission Number L pq (seal) s (seal) NOTE: TWO (2) SIGNATURES ARE R IF APPLYING FOR THIS BUILD TO SIGN THIS APPLICATION IN EACH SIGNATURE MUST BE NOTARIZED. LY APPEAR f AS AN OWNER/BUILDER, THE OWNER MUST PERSON ICE LISTED ON THE FRONT OF THIS APPLICATION. BP #: C.151 00-y� SECTION: TOWNSHIP: �7J RANGE: MAP NO.: ZONING 1 i" LAND USE: \ / Y (_.J LOT CVG %: TAZ NO FLOOD ZONE: FIRM MAP #: 1ST V: MAX HGT. CST TYPE: OCCP TY MAX. OCCP: # OF FLRS: WATER:- SEWER:. SPRINKLERS STORMWATE R LOT OF REG (befr 1190) LOT OF REC (aftr 1/90) LOT SPLIT LOT SPLIT REQ'D APPRV'D DECAL LIBRARY PARKS PERMIT NUMBER IMPACT FEE IMPACT FEE FEE REPORT PUBLIC BLDG HABITABALE RADON FEE CODE %% IMPACT FEE AREA V (RADON) Y N .'ROAD GROSS ROAD CREDIT TOTAL ROAD IMPACT ZONE IMPACT FEE IMPACT FEE DUE SCHOOL CREDIT TOTAL IMPACT FEE I POLICE FEE ADDITIONAL PERMITS REQ'D REVIEW,; DATE COMPLETI FIRE FEE Y I N I SPECIFY: ZONING I ZONING PLANS I BY EXA REVIEWED MINING 0- SCHOOL :'aka+{...,...... IMPACT FEE r MISC FEES: TOTAL - POLICE/FIRE/ MISC. FEES TOTAL ALL FEES VEGETATION I SEA I MANGROVE INITIALS